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P. 194
ariasis
– I v erm ectin ( and possibly albend azole) is used to red uce m icrofilaraem ia before
ad m inistration of D E C ; h ow ev er, iv erm ectin ad m inistration m ay trig g er
enceph alopath y in patients w ith v ery h ig h Loa loa m icrofilaraem ia (> 3 0 0 0 0
m f/ m l).
– D oxycycline is not ind icated since Loa loa d oes not h arbour Wolbachia.
– M anag em ent:
1) L. loa microfilaraemia is < 1,000-2,000 mf/ml:
A 2 8 -d ay treatm ent of DEC m ay be started using sm all d oses of 3 to 6 m g / d ay, i.e.
1 / 3 2 or 1 / 1 6 of a 1 0 0 m g tablet, ad m inistered in 2 d iv id ed d oses. D ouble th e
d ose
ev ery d ay up to 4 0 0 m g / d ay in 2 d iv id ed d oses in ad ults ( 3 m g / kg / d ay in
ch ild ren).
OIf .mvoilcvruolfuilsa,raiveemrmeiactionr (s1ym5 0pmtomicrsogperrasmist,sa/ skegcoansdatsreinagtmle denotsies)gtreivaetsno4ncwh oeceekrscilasteisr,.
I f D E C is contra- ind icated d ue to possible or confirm ed co- infection w ith
and red uces pruritus and frequency of C alabar sw elling s. T h e treatm ent m ay be
repeated ev ery m onth or ev ery 3 m onth s.
2) L. loa microfilaraemia is between 2,000 and 8,000 mf/ml:
R ed uce m icrofilaraem ia w ith ivermectin (1 5 0 m icrog ram s/ kg as a sing le d ose);
repeat
th e treatm ent ev ery m onth if necessary; ad m inister D E C w h en th e
m icrofilaraem ia is
< 2 0 0 0 m f/ m l.
3)mL. loeammbicerro(fsil)aarareemneiaceisssbaertywe. ePnr8e,s0c0ri0beanpdar3a0c,e0t0a0mmfo/ml al:s w ell for 7 d ays.
T reatm ent w ith ivermectin (1 5 0 m icrog ram s/ kg as a sing le d ose) m ay cause
m arked
functional im pairm ent for sev eral d ays. C lose superv ision and support from fam ily
5
4) L. loa microfilaraemia is > 30,000 mf/ml:
• I f th e loiasis is w ell tolerated , it is preferable to refrain from treatm ent: th e
adsisaeassinegislebdenoisgen) iasnadd mtreaintmisteernetdwfoirth5 idvaeyrsmunedcteinr smupearyvciasiuosneinv heroysspeitvael re.aAd vnerse
reactions (enceph alopath y), albeit rarely.
• I f loiasis h as a sig nificant clinical im pact and / or th e patient presents w ith
sym ptom atic onch ocerciasis requiring treatm ent, ivermectin (1 5 0 m icrog ram s/ kg
6
attem pt to first red uce L. loa m icrofilaraem ia using albendazole (4 0 0 m g / d ay in
2 d iv id ed d oses for 3 w eeks) is an option. W h en L. loa m icrofilaraem ia is <
3 0 0 0 0 m f/ m l, treat w ith iv erm ectin und er close superv ision and support, th en
D E C w h en th e m icrofilaraem ia is < 2 0 0 0 m f/ m l.
Extraction of macrofilariae
Subcutaneous m ig ration of a m icrofilaria usually results from treatm ent w ith D E C ; th e
w Poartimentswmailyl dprieesebnetnweiaththvartihoues spkaiinn asynnddreomxteras,cbtienguniatbsleertvo emsonveo wpiuthropuotshee.lp or unable to move at all.
R em ov al of an ad ult w orm from th e conjunctiv a: see pag e 1 2 8 .
A severe reaction may occur on D2-D3. It is usually preceded by haemorrhages of the palpebral conjunctiva on
5
Monitoring is necessary to determine whether the patient can manage activities of daily living, and provide
assistance if necessary. If the patient remains bedridden for several days, ensure pressure sores do not develop
(mobilisation, repositioning).
6
D1-D2. Routinely check for this sign by turning back the eyelids. Symptoms of post-ivermectin encephalopathy
are reversible and the prognosis favourable, if the patient is correctly managed; the treatment is symptomatic
until symptoms resolve. Avoid the use of steroids due to adverse effects.
– I v erm ectin ( and possibly albend azole) is used to red uce m icrofilaraem ia before
ad m inistration of D E C ; h ow ev er, iv erm ectin ad m inistration m ay trig g er
enceph alopath y in patients w ith v ery h ig h Loa loa m icrofilaraem ia (> 3 0 0 0 0
m f/ m l).
– D oxycycline is not ind icated since Loa loa d oes not h arbour Wolbachia.
– M anag em ent:
1) L. loa microfilaraemia is < 1,000-2,000 mf/ml:
A 2 8 -d ay treatm ent of DEC m ay be started using sm all d oses of 3 to 6 m g / d ay, i.e.
1 / 3 2 or 1 / 1 6 of a 1 0 0 m g tablet, ad m inistered in 2 d iv id ed d oses. D ouble th e
d ose
ev ery d ay up to 4 0 0 m g / d ay in 2 d iv id ed d oses in ad ults ( 3 m g / kg / d ay in
ch ild ren).
OIf .mvoilcvruolfuilsa,raiveemrmeiactionr (s1ym5 0pmtomicrsogperrasmist,sa/ skegcoansdatsreinagtmle denotsies)gtreivaetsno4ncwh oeceekrscilasteisr,.
I f D E C is contra- ind icated d ue to possible or confirm ed co- infection w ith
and red uces pruritus and frequency of C alabar sw elling s. T h e treatm ent m ay be
repeated ev ery m onth or ev ery 3 m onth s.
2) L. loa microfilaraemia is between 2,000 and 8,000 mf/ml:
R ed uce m icrofilaraem ia w ith ivermectin (1 5 0 m icrog ram s/ kg as a sing le d ose);
repeat
th e treatm ent ev ery m onth if necessary; ad m inister D E C w h en th e
m icrofilaraem ia is
< 2 0 0 0 m f/ m l.
3)mL. loeammbicerro(fsil)aarareemneiaceisssbaertywe. ePnr8e,s0c0ri0beanpdar3a0c,e0t0a0mmfo/ml al:s w ell for 7 d ays.
T reatm ent w ith ivermectin (1 5 0 m icrog ram s/ kg as a sing le d ose) m ay cause
m arked
functional im pairm ent for sev eral d ays. C lose superv ision and support from fam ily
5
4) L. loa microfilaraemia is > 30,000 mf/ml:
• I f th e loiasis is w ell tolerated , it is preferable to refrain from treatm ent: th e
adsisaeassinegislebdenoisgen) iasnadd mtreaintmisteernetdwfoirth5 idvaeyrsmunedcteinr smupearyvciasiuosneinv heroysspeitvael re.aAd vnerse
reactions (enceph alopath y), albeit rarely.
• I f loiasis h as a sig nificant clinical im pact and / or th e patient presents w ith
sym ptom atic onch ocerciasis requiring treatm ent, ivermectin (1 5 0 m icrog ram s/ kg
6
attem pt to first red uce L. loa m icrofilaraem ia using albendazole (4 0 0 m g / d ay in
2 d iv id ed d oses for 3 w eeks) is an option. W h en L. loa m icrofilaraem ia is <
3 0 0 0 0 m f/ m l, treat w ith iv erm ectin und er close superv ision and support, th en
D E C w h en th e m icrofilaraem ia is < 2 0 0 0 m f/ m l.
Extraction of macrofilariae
Subcutaneous m ig ration of a m icrofilaria usually results from treatm ent w ith D E C ; th e
w Poartimentswmailyl dprieesebnetnweiaththvartihoues spkaiinn asynnddreomxteras,cbtienguniatbsleertvo emsonveo wpiuthropuotshee.lp or unable to move at all.
R em ov al of an ad ult w orm from th e conjunctiv a: see pag e 1 2 8 .
A severe reaction may occur on D2-D3. It is usually preceded by haemorrhages of the palpebral conjunctiva on
5
Monitoring is necessary to determine whether the patient can manage activities of daily living, and provide
assistance if necessary. If the patient remains bedridden for several days, ensure pressure sores do not develop
(mobilisation, repositioning).
6
D1-D2. Routinely check for this sign by turning back the eyelids. Symptoms of post-ivermectin encephalopathy
are reversible and the prognosis favourable, if the patient is correctly managed; the treatment is symptomatic
until symptoms resolve. Avoid the use of steroids due to adverse effects.
